Is Fatigue A Figment of Your Imagination?

Yesterday on my way to work I listened to an interview about a new book on sports science on NPR.  The guest was Mark McClusky, an editor with WIRED.com, who discussed his new book Faster, Higher, Stronger - a book on sports science.  The interview discussed Mark's research into a number of methods that elite athletes use to attain better performance - many of which I have or intend to explore - so I decided to get a copy.  My copy arrived today and I dove into a chapter in the middle called "What Getting Tired Means".

The chapter highlights the theories of sports scientist Tim Noakes, who contends that fatigue is not a physiological state caused by the increase in lactate (or acidification) of muscles but rather a mental state, "a combination of the brain reading various physiological, subconscious and conscious signals and using these to pace the muscles in order to ensure that the body does not burn out before the finish line is reached."

Faster, Higher, Stronger implies that Mr. Noakes' view remains controversial in the sports science field and, in my opinion, with good reason (although I do think there are some interesting ideas and takeaways).  For one, muscle fatigue is not limited to elite athletes or endurance sports.  Muscle fatigue and fatigue in general has an entirely different context in the world of chronic illness.  Just the other night, while blow drying daughter's hair, turning the two pound hair dryer quickly back and forth so as not to leave the heat concentrated in any one place for too long, my forearm muscles began to tire.  They got heavy, much the same as used to occur when I was able to exercise at a high level, and ultimately struggled to hold up the two pound hair dryer.  I think it unlikely that muscle fatigue in this case was my brain trying to pace the use of my forearm to dry my daughter's hair.

That said, the correlation between the mind and exercise performance appears real from what I have read.  The brain is the control center of the body, regulating your body's systems (e.g. circulatory, nervous).  Each of those systems includes various organs and other tissues that have different functions, require different resources (e.g. oxygen, minerals, vitamins), and produce different waste products.   The brain cannot override the number resources required or eliminate the waste products; however, it can push through the normal safety limits for short periods of time. 

It is possible that Mr. Noakes' view is more nuanced that implied in Faster, Higher, Stronger by Mr. McClusky - that he is attributing the very small increase in exercise performance of "gold medal" athletes that allows them to temporarily push through the body's safety switches (by trickery or mental fortitude) - but the notion that fatigue is somehow an emotional or mental state does not seem plausible in the context of illness induced fatigue.

The Goods (Recipe) - Fried Mushrooms

They key to a good fried mushroom is cooking over high heat  and with a modest amount of mushrooms so that they fry instead of steam.  I usually make these mushrooms as part of another dish but can't help sneaking a few as a snack.

1 c. Mushrooms, sliced
2 Tblsp. Avocado Oil (or another oil with a high smoke point)
Salt





(1) Heat a pan on high or medium high heat.  Add oil.  Once oil is hot, add sliced mushrooms.  Make sure the mushrooms are in a single later on the pan's bottom and allow to cook until golden brown.  Then turn over and cook until the other side is golden brown.  Add a dash of salt and serve.

Algae Virus May Be Changing the Way You Think

Ran across this article during my morning reading.  I haven't started writing about the causes of chronic illness, yet, but viruses are certainly on the list - especially those that aren't currently recognized as impacting humans.  So this article was of particular interest.  Check it out at the Business Insider by clicking the following link...

Algae Virus May Be Changing the Way You Think

The Goods (Recipe) - Basic Panelle (Chickpea Polenta) w/ Chimichurri Sauce

Basic Panelle with Chimichurri Sauce

Yotam Ottolenghi's new book, Plenty More, features unique vegetable focused dishes (though not usually allergen-free).  While flipping through the book this weekend, I noticed a few interesting dishes that featured polenta - a cornmeal based dish (i.e. not on my diet).  After a quick internet search I found a traditionally Sicilian dish called Panelle, which made in the exact same fashion as polenta but with chickpea flour.  After some experimentation, I am quite the fan.  The Panelle itself is relatively neutral in taste, but the crispy exterior and creamy interior combined with a sauce of your choice makes this dish an absolute star.

 2 c. Chickpea Flour
4 c. Chicken Stock (or water)
1 tsp. Salt
1/2 c. Extra Virgin Olive Oil

Chimichurri Sauce (optional)

(1) Combine stock, salt, and extra virgin olive oil in a sauce pan.  Whisk to combine.

(2) Place sauce pan over medium to medium low heat.  Gradually whisk in chickpea flour.  Continually whisk until mixture thickens to the point where it just about comes away from the side of the pan, 20 - 30 minutes.  Note: if you don't cook (and continually stir) for this long, the finished product will be much more difficult to fry.

Cooled Panelle

(3)  Turn off heat.  Pour thickened mixture into an oiled 9" x 13" pan and allow to cool for anywhere between 1 hour and 3 days in the refrigerator.

 (4) Once cooled heat some more olive oil in a pan over medium heat.  slice the Panelle into squares and fry on both sides until golden brown.

The Goods (Recipe) - Savory Strawberry & Apricot Salad with Chicken

When strawberries are at their peak of perfection in the summer (or longer here in California), this salad is one of my go-to lunches.  The sweetness of the strawberries and apricots works in beautiful harmony with the salty acidity of the dressing.

4 Dried Apricots, Diced
1/2 Large Cucumber, Diced (and peeled and/or de-seeded)
1 c. Chopped Spring Mix (or Lettuce)
1/2 c. Chicken, Diced (from a roasted chicken)
1 Carrot, Sliced
3 Tbls. Roasted Sunflower Seeds
1/2 c. Diced Strawberries
1/2 Medium Avocado, Diced

3 Tbls. Balsamic Vinegar
1/4 c. Extra Virgin Olive Oil
Sprinkle of Salt

(1) Clean and cut all ingredients  If using raw sunflower seeds, dry toast them in a pan the same as when making sunflower seed butter (click here for that recipe).  Add to a bowl.  Mix and enjoy!

The Frontier of Alternative Medicine

In my search for cures, several good theories for new alternative therapies have come to my attention.  The Frontier of Alternative Medicine is a new series in the blog that will discuss a few of these frontiers.

The Goods (Recipe) - Peppermint Tea

This tea is a basic peppermint tea.  I prefer most teas without sugar - so expect a subtle peppermint flavor.

3 Stems of Fresh Peppermint Leaves (~5" Long)
1 c. Water






(1) Wash peppermint leaves and stems.  Mint stems are fine to use in this tea.  

(2) Bring water to a boil.  Boiling water is necessary to extract the oils from the peppermint leaves, so no cutting corners on this step.

(3) Add mint stems and leaves to boiling water and immediately turn off the heat.  Let leaves and stems steep for 5 - 10 minutes.  Strain into a cup and enjoy.

Peppermint Tea

On Herbs - Mint

Spearmint in Our Backyard

Peppermint and Spearmint are the two herbs in the mint family.  Both have similar compounds, though spearmint is considered to be more mild.  Both are an easy-to-grow herb that I remember as running rampantly wild in my backyard as a kid.  Peppermint oil is most popular as a flavoring in peppermint candies (no kidding) and in candy canes and less familiar as an accoutrement to lamb.  Both are used for chewing gum.  We grow spearmint in the garden in our backyard where we have a steady supply of the fragrant and tasty herb year-round.  Mint (both spearmint and peppermint) is a Group A herb.  For more on group classifications see the On Herbs post by clicking here. 

The Science

The science is in - peppermint oil has been documented as helpful with digestive conditions such as irritable bowel syndrome (IBS) in several studies according to the National Institutes of Health.

Additional Potential Uses

 A 1996 paper by Koren Holland, Phd., at Gettysburg College in Gettysburg, PA documented plants utilized by the migrant (primarily Mexican) community for various ailments.  This study documented that the migrant community used peppermint to aid with indigestion, colds, and relief for insomnia.  Menthol is also known to increase the flow of bile to the stomach, which promotes digestion.  Externally, the migrant community indicated that peppermint oil or menthol is used in pain relieving balms, massage oils, and lineaments and that inhalation of the herb or oil are effective against excessive respiratory mucus.

My Personal Experience

I started to dabble in spearmint tea a short time ago during a flare up of IBS.  Although used in conjunction with other therapies, my IBS flare up disappeared shortly after starting a daily consumption of spearmint tea. 

Preparations

Mint Tea

Click here for the alternative road recipe page, which will include recipes for all preparations listed.

Additional Resources

The National Institutes of Health (NIH) has a Natural Center for Complementary and Alternative Medicine (NCCAM) that talks about the science on peppermint oil.  Click here to read what the NIH NCCAM has to say on the subject.

Warning Science Ahead: The Autonomic Nervous System

Meditative breathing and heart rate variability has been proven to help balance the autonomic nervous system.  But what exactly is the autonomic nervous system?  This video, available on Khan Academy does a great job of explaining... 


    Autonomic nervous system (ANS) and physiologic markers of emotion:

Experimenting with Diet - The 5:2 Fasting Diet

What is the 5:2 Fasting Diet?

The 5:2 Fasting Diet is advocated by Dr. Michael Mosley.  The basic idea is to consume 600 calories or less for two days per week, every week to lose weight and live longer.  I first ran into the concept of the diet when researching fasting as a possible alternative therapy and ran into a BBC special called Eat, Fast, and Live Longer, an hour long special by Dr. Mosley that discusses calorie restriction as a secret to improved health and longer life.  The diet appears to be based on valid scientific research - predominantly that of Dr. Krista Varady (whose research validates an alternative day fasting diet, not the 5:2 fasting diet) - but attempts to minimize the frequency of fasting days. 

Click here to watch Eat, Fast, and Live Longer

The Experiment

In 2013, I stuck with the 5:2 fasting diet for two months and kept a detailed count of my calories using an online calorie counting program (Nutritional Assessment Tool) through the University of Illinois.  A typical fasting day:  A low-calorie smoothie for breakfast, water for lunch, lean meat and vegetables for dinner.  Hunger was a constant, headaches a companion, on fasting days.  The saving grace of the diet is that on the remaining five days of the week, you can eat whatever you wanted.  I took this part of the diet seriously and consumed cheeseburgers, french fries, pizza, donuts, and a host of other guilty pleasures.  Unfortunately, after two months of the diet, I neither felt improved health or had lost weight. 

My Take-a-Way

I have read and am inclined to believe that the weight loss effects of the 5:2 fasting diet are likely due to a net reduction in caloric intake over the entire week, which did not happen in my case - too many sweets.  Possible health improvements (metabolic, due to the fasting) are plausible but were not noticeable for my experience.  Dr. Varady also asserts that her diet, the alternative day fasting diet, is the only diet substantiated by her research and has more consistent results than the 5:2 fasting diet.  Click here for a Question and Answer session by Dr. Varady discussing the differences.  I have not tried the alternative day fasting diet but since I did not have success with the 5:2 diet may give it a whirl.  For the meantime, I do not discount the 5:2 fasting diet - I will only say that it did not work for me.

If you are interested in learning more about the 5:2 fasting diet, click here for Dr. Mosley's Website.

The Goods (Recipe) - Sweet Potato Hash

I have dabbled with sweet potato hash in the past but couldn't quite get the right crisp without burning the sweet potatoes.  With my new found knowledge on the amazing properties of garbanzo bean flour, this hash is crispy on the outside and creamy on the inside, just like a good hash is supposed to be.   

1 Small Sweet Potato
 1/3 c. Diced Onion
1/8 c. Garbanzo Bean Flour
1/2 c. Diced chicken (or Turkey or leave it out for a vegan dish)
6 Tbls. Bacon Fat (or Olive Oil or leave it out for a vegan dish)
Thyme
Salt
Pepper
Roasted Garlic Spread (Optional)

(1) Grate sweet potato on a coarse grate setting.  Dice onion.  Add all ingredients (thyme, salt, and pepper to taste) to a bowl and mix thoroughly.

(2) Heat a non-stick pan with bacon fat on medium heat (if using a small pan, make two batches each with half the bacon fat).  Once to temp, add the has mixture and press down into the fat.  Cook on each side for approx. 2 - 3 minutes or until the potatoes have reached a dark brown (but not burnt) look.

(3) Spread optional roasted garlic spread if desired and enjoy.

On Herbs

Herbal remedies have been used for millennia for treating a variety of ailments.  But what are herbs?  I was most familiar with them in a cooking context - plants like thyme, mint, rosemary, and sage used to add flavor to foods.  It turns out that the term "herb" is given a far more generous definition as any plant and any part of the plant valued for medicinal, aromatic, or savory qualities.  From a medicinal standpoint, herbs can be an invaluable addition to the alternative road.  And there is emerging science to back up some of common wisdom.  Accordingly, a new series in the blog titled On Herbs will discuss the medicinal applications of herbs.

Information on herbs posted in this blog will attempt to classify the usefulness of each herb in a tiered structure, modeled after the Austrailan Institute of Sports hierarchy, as described further below. 

Group A:  Herbs included in this group are those for which good scientific evidence exists for defined benefits.  The National Institutes of Health (NIH) has a division called the National Center for Complementary and Alternative Medicine (NCCAM) and discusses a number of scientifically validated uses for herbs.  These herbs are virtually guaranteed to provide the defined benefit.

Group B:  Herbs included in this group are those for which some scientific evidence shows promise of benefit but the scientific evidence may not be conclusive.  I will also include herbs in this group that have multiple alternative traditions recommending them for the same ailment or benefit.  Herbs in this group are likely to provide the defined benefit but results cannot be guaranteed. 

Group C:  Herbs included in this group are those that have no scientific evidence of meaningful effects or that are recommended by only one alternative tradition for a particular ailment or benefit.  Herbs in this group may but are less likely to provide any benefit.

Group D:  Herbs in this group have been shown to be harmful or their benefits are offset by disadvantages.

The Goods (Recipe) - Orange Coconut Smoothie

A tropical smoothie with lots of flavor.  Add spinach to get your greens (though the color won't be quite as nice...

2 Oranges

1 c. Frozen Strawberries
3 Tbls. Coconut Oil
3 Tbls. Flax Seed
4 Dates
1 c. Coconut Water




(1) Peel oranges.  Pit Dates.  Add all ingredients to a high-speed blender.  Blend until thoroughly combined.

The Goods (Recipe) - Pan Steamed & Sauteed Broccolini

Broccolini (aka Broccolette) is a cross between broccoli and Chinese kale.  It is mild flavored, nutritious, and a great addition to any meal.  Ingrid and I just started cooking with Broccolini and started with a simple recipe.

Shown with the roasted garlic spread

8 stalks Broccolini
1/4 c. Water
3 tbls. Olive Oil
Salt
Pepper

1 tbls. Lemon Juice (optional)
Roasted Garlic Spread (optional)

(1) Place water and broccolini in a pan over medium heat.  Cover with a lid but leave a small opening for the steam to escape.

(2) When the water has almost boiled off completely, remove the lid and add the olive oil to the pan.  Sautee over medium heat, stirring occasionally, until the broccolini starts to brown.  Season with salt and pepper.  Add garlic spread or lemon juice, if using, stirring to incorporate, then turn off heat and serve. 

The Alternative Road - Meditative Breathing

Learning to breath properly was a foreign concept to me a few years ago.  In fact, I hadn't given it any thought until Dr. Berkoff recommended that I consult with a biofeedback expert.  Though I was excited at the prospect of a new therapy with scientific basis, I was very curious as to how biofeedback worked.  Biofeedback is a generic term for equipment that measures the body's response to normal functions (like breathing) or external stimulus.  In this case, Dr. Berkoff recommended that I see Dr. Gevirtz, a specialist in biofeedback for meditative breathing.  I had heard of meditative breathing - even dabbled in it while doing Yoga.  But I didn't understand the connection between breathing and health.  Wasn't breathing innate and self-regulated?  The answer to that question was yes.  So wouldn't it follow that we would naturally breath for optimal health?  The answer to this question surprised me.  It was a big fat resounding NO... or at least not all of the time.  

Meditative breathing has been practices by yogis, swamis, Buddhists, and various other practitioners for millennia.  These practitioners have been able to control bodily functions (such as heart rate) that are not typically thought of as controllable.  It is only recently that science has begun to look into and understand these phenomenons and their connections with breathing.

The science revolves around something called heart rate variability (HRV).  You are probably familiar with your resting heart rate, normally taken at the doctor's office and given to you as a single number somewhere between 50 and 80 beats per minute.  This single number is actually an average heart rate.  For the most part, when we exhale, our heart beats slower than when we inhale.  HRV is a measure of the pace between heart beats over time.  Erratic HRV is associated with stress, fatigue, and an overactive parasympathetic nervous system.  A regular or even HRV is associated with a balanced autonomic nervous system and good health.

Below are actual screenshots of my HRV using a program and attachment produced by a company called Heartmath to show you the difference between an erratic HRV and a regular HRV. 

Erratic HRV - Adam Hoch

Notice the uneven spacing between the vertical red lines, indicating erratic breathing and providing for poor HRV.  Compare that to the evenly spaced vertical red lines, indicating regular breathing and excellent HRV in the figure below.

Regular HRV - Adam Hoch

According to Dr. Gevirtz, the research shows that meditative breathing for only ten minutes per day a couple of times per week can have a noticeable impact on health.

IF YOU ARE SUFFERING
If you are suffering from any symptoms that could be attributed to stress, anxiety, or an unbalanced autonomic nervous system, including dry mouth, poor digestion, anxiety, etc., meditative breathing may help.  The goal is to find your optimal breathing rhythm and to practice breathing for at least 10 minutes four times per week.  I have found three avenues for finding your optimal breathing rhythm as discussed below.

1. There is a free app called My Calm Beat that you can download to your smartphone.  It is a fairly basic program but allows you to input your optimal breathing pace (mine is 6 breaths per minute to give you a benchmark) and pace your breathing.
2. For those who are interested in tracking their HRV a little closer, the company mentioned above called Heartmath has developed an instrument that clips to your ear and connects to your smartphone.  The display can track your heart rate variability to provide a visual of your HRV.
3. Alternately, you can schedule an appointment with someone who specializes in this type of biofeedback, like Dr. Gevirtz.  Click here to read more about Dr. Gevirtz and his work.

The Depths of Illness - Sun Sensitivity

Shortly after getting off of the Appalachian Trail in 2005 with a diagnosis of Lyme's Disease, I took a job installing solar panels in the northeast - in Massachusetts, Vermont, Connecticut, and New York.  Day in and day out I was on roofs or on the ground in high sun exposure areas.  I wore sunscreen but the sun felt different than I remembered.  Instead a pleasant warmth, the sun light burned.  The feeling reminded me of lighting my finger on fire (a brief obsession in high school).  The trick was to spray a high-alcohol breath mint spray onto my finger and then set it ablaze with a lighter or match.  The heat became unbearable just about the same time the alcohol burned off  and the fire extinguished (although I remember putting the fire out with a shake of the hand most of the time).  This almost unbearable heat - as if my skin had just been set ablaze but had not yet registered the full fury of the fire - was how the sun felt on my skin.  I put on more sunscreen.  It didn't help.  Shade, clouds, and night became well-loved friends.

I found out from my father that sun sensitivity was a side effect of the antibiotic I was on, Ciprofloxacin, for the Lyme's disease, which gave me hope that my new aversion to the sun was a temporary state.  It was not.  Within a few months Ingrid and I moved to San Diego, which is in the top ten US cities for average hours of sunshine each year.  The feeling of burning while in the sun forced me indoors.  I sought apartments on the north side of apartment buildings or sheltered with trees.  The apartments were dark, damp, and cold - which I preferred but Ingrid did not.  I made excuses to stay inside while Ingrid went out to explore, to play beach volleyball and enjoy other sun-exposed activities.  The few times that I indulged in activities in the sun, I suffered the consequences - skin that burned while outside and radiated heat for hours afterward, headaches, and irritability.   

Why I Speak

When my health issues first began, I fully trusted that western medicine would ferret out the cause and prescribe a treatment.  It did not happen.  I had doctors, including my father, who were willing to explore every possible defined cause for my ailments (even those that were possible but extremely unlikely) and try treatments for possible but unconfirmed illnesses.  I also had doctors who advised me that my symptoms were a natural part of the aging process.  It took a number of years for me to understand that western medicine did not have all of the answers, which was when I turned to alternative medicine.  I speak to those who have reached the limits of western medicine

Back in 2006 my grandmother died from a stroke.  The stroke was the culmination of a long stint of illness, irritability, depression, and nausea.  When my grandmother stopped eating, the family intervened - convinced her to see a doctor.  Her doctor essentially told her that she was getting old and suggested that in lieu of eating she drink Ensure to get sustenance.  I am quite sure that my grandmother's doctor's apathy toward her situation helped to seal her coffin.  I speak to those who are being ignored or diminished by the system.

When my grandfather died a few years later, his cabinets were full of powdered herbs and tonics - supplements he was experimenting with to improve his quality of life.  I speak to those looking for guidance on improving their quality of life.

Every structured alternative therapy claims to have an approach to every ailment - but having an approach to an ailment does not equal having an answer.  Sifting through numerous approaches looking for answers has been a long and mostly frustrating journey.  I hopped blindly from one alternative therapy to another, looking for snippets of wisdom that might help .  While I ran into many alternative practitioners who genuinely wanted to help, I ran into few who actually could help.  Each plausible therapy (therapies with overwhelming anecdotal evidence, solid theories, and/or scientific evidence) that I've tried offered a unique perspective and insight into health, some providing evidence for pieces to what I now believe is a complex puzzle that facilitates chronic illness.  I speak to share what I have learned.  I am not a practitioner beholden to one approach to chronic illness, I am someone on the journey aggregating my experiences and trying to organize them into useful information for anyone looking for help. I speak to those looking for answers. 

I speak because I have learned that it is possible to rise from the shadows of chronic illness.  There is hope.  If you are suffering and do not see specific guidance in this blog for your ailment or symptoms, write me a comment letting me know and I'll get back to you as soon as I can.       

The Goods (Recipe) - Low Amine Chili

I was looking around the internet for a good ground beef recipe the other week and ran across a low-amine blog with a night-shade free chili (an oxymoron, I know).  I have dabbled with a nightshade-free Cincinnati chili recipe (not quite ready for posting) and was very interested to try someone else's recipe to get more ideas on how to mimic the chili flavor without using any chilies or chili powder.  I am not quite caught up on the amine allergy/intolerance but this recipe is allergen-free and worth the time to make (though next time I would make it without the beans).  You can find the recipe at this Low Amine Blog.

Warning: Science Ahead - Autoimmune Diseases

I ran across this video on Khan Academy discussing how the immune system knows the difference between actual danger and perceived danger.  A good video to understanding the biological basis for autoimmune disease.

The Goods (Recipe) - Roasted Garlic Spread

Roasted garlic spread adds an unparalleled level of garlic flavor to your pantry.  Use it as a topping for steak, hamburgers, broccolette (broccolini), spinach, or a variety of other meats and vegetables.  I have been known to eat a spoonful of the raw spread for good measure on occasion. 

5 Heads of Garlic
1/4 c. Olive Oil plus 1 tbls.
Salt
Pepper






(1) Turn oven to 400 degrees F.

(2) Slice garlic heads in half - through each clove - and place in a line on aluminum foil.  Sprinkle with salt and 1 tbls. olive oil.  Close foil around garlic and crimp to keep all moisture inside the foil pack.  Bake for 40 minutes.  Remove from oven and allow to cool to touch.

(3) Once the garlic has cooled to touch, squeeze the roasted garlic cloves out of the skin and into a bowl.  Add the remaining olive oil, salt, and pepper and mash with a fork.